Forensic Psychiatry and Psychology in Europe by Kris Goethals

Author:Kris Goethals
Language: eng
Format: epub, pdf
Publisher: Springer International Publishing, Cham

11.5 The Historical and Conceptual Roots of Forensic Psychotherapy in the United Kingdom

In the United Kingdom (UK), the discipline of forensic psychotherapy has developed mainly within the National Health Service (NHS), as opposed to the Criminal Justice System, and was pioneered by psychiatrists and forensic psychiatrists, many of whom were also psychoanalysts and group analysts. Although there were several pioneers who worked independently in prisons and secure forensic units, the institutional cradle for the development of the discipline was the Portman Clinic, part of the Tavistock and Portman NHS Foundation Trust, London. The clinic grew from the idea of a small group of psychoanalysts who wanted to establish that there was a better way of dealing with offenders rather than incarcerating them in prison. Thus, forensic psychotherapy developed from psychoanalysis, psychodynamic psychotherapy and forensic psychiatry and psychology and refers to the application of psychoanalytic principles and treatment in the service of understanding and managing mentally disordered offenders, irrespective of whether these individuals are in secure NHS units, prisons or the community. In other words, forensic psychotherapists not only provide treatment but also apply psychodynamic thinking to the complexities and dynamics within staff teams and institutions treating these individuals [27]. One of the unique selling points of forensic psychotherapy is that central to its work is a psychoanalytic consideration of the unconscious mind and the internal world of the patient. This contributes an additional dimension to understanding the mind, criminal acts and ongoing risk of the offender [11, 28–31].

Forensic patients have highly disordered and fragmented internal worlds. They rely on primitive unconscious defence mechanisms in an attempt to stabilise their inner world. Aspects of the patients’ internal world can be projected into staff and evoke reactions in both the staff and the institution that arise either from the unconscious response of staff to the projected aspects of their patients’ internal world or from mobilisation of the unconscious defence mechanisms of the staff and the institution to reduce internal anxiety. If left unattended, these processes result in staff teams becoming ‘split’ and reenacting aspects of the patients’ intrapsychic and interpersonal situation within the professional network. The therapeutic potential of the environment is decreased along with the effectiveness of the particular therapeutic task, irrespective of whether this is one of containment, assessment or treatment [32]. The understanding that forensic psychotherapists can bring to the intrapsychic function and the interpersonal consequences of such splitting for both their patients and the systems in which they work can significantly contribute to assessment, treatment and risk management [33]. However, to achieve this, it is crucial that forensic psychotherapy is a team effort [34] and, as such, embraces inter-professional, interdisciplinary and interagency working. The impetus for the further development of forensic psychotherapy came from two drivers: one creative and the other tragic.

To further multi-professional expertise in forensic psychotherapy and to encourage the growth of the discipline beyond psychoanalytic departments and clinics in the United Kingdom, Dr. Estela Welldon established the first training course in Forensic Psychotherapy in 1989 which was accredited by the University of London and run at the Portman Clinic.

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